Caregiver Corner
By Jennifer Beach
Janet talks to her mom almost every day. Since she lives out of town, making these daily calls can be beneficial in multiple ways, including giving her mom reminders, such as taking her daily medications. Janet would like to hire a caregiver to assist her mom at least a few times a week… someone to check in, have some conversation with, help around the house and even go to the store, if needed. Janet is getting concerned about her mom’s safety, yet her mom does not seem to be aware of the changes taking place. Her mom will get upset or angry with her daughter when she raises concerns. Janet thinks her mom is in denial and is being stubborn. Janet is at a loss; even the neighbors have brought up their concerns to Janet about her mom’s memory and safety.
Janet’s situation with her mom is all too common and something so many families are challenged with. The lack of self-awareness or the ability to realize one’s limitations is known as “anosognosia dementia.”
What is Anosognosia?
Anosognosia is a medical term used to describe a lack of awareness or insight into one’s own condition or illness. It often occurs in individuals with various forms of dementia, including Alzheimer’s disease. When anosognosia is specifically associated with dementia, it is referred to as anosognosia dementia. Statistics show that up to 98% of those with dementia also have anosognosia.
The way we form a mental picture of ourselves, our self-awareness, is an ongoing process throughout life. The frontal lobe of the brain takes in information constantly, and uses this to construct your personal image, and awareness of yourself and the world around you.
Damage or changes to the frontal lobe’s ability to take in or process information can stop this from working, which is what causes anosognosia.
Anosognosia dementia refers to the inability of individuals with dementia to recognize or acknowledge their cognitive impairment. Anosognosia occurs on a spectrum. Some individuals merely experience forgetfulness about their state or their condition in its early stages, while some exhibit varying levels of self-awareness and memory loss as their condition progresses. Some will become completely unable to accept their diagnosis or even remember who they are at all.
Some individuals may be unaware of their memory loss, language difficulties, disorientation and other cognitive deficits associated with their condition. This lack of awareness can be challenging for both individuals and their loved ones. Often, it may lead to difficulties in accepting the diagnosis, seeking appropriate care and following treatment plans.
Anosognosia dementia is believed to result from damage to certain areas of the brain that are responsible for self-awareness and insight. The exact mechanisms underlying this condition are not yet fully understood. Researchers suggest that it may involve the dysfunction of neural networks involved in self-monitoring and self-evaluation.
Different From Denial
It’s important to note that anosognosia dementia is different from denial or simply forgetting. Denial involves a conscious refusal to accept or acknowledge a problem, whereas anosognosia is characterized by a genuine lack of awareness that is not under the person’s control. As anosognosia is a result of changes to the brain it is not something that will be fixed by evidence. Anosognosia sufferers can be presented by multiple diagnoses from people they trust and will still be unable to accept that they have a problem.
Anosognosia is rooted in neurological changes rather than a deliberate choice to ignore or deny the condition.
What to Do?
Caring for someone with anosognosia is challenging, to say the least. The condition is not easy to treat, and it can be extremely stressful. It is such a complex issue; if the individual does not believe or will not accept that there are changes taking place and assistance and support is needed, then they are unlikely to accept treatment or care.
Medication in some individuals can be beneficial and may help improve self-awareness and maybe reduce their inability to accept their diagnosis, resulting in being more accepting of assistance/support. Most times, the best results come from a more roundabout approach— showing the individual benefits of having some support with regard to other aspects of their life, such as continuing to live as independently as possible.
As with most aspects of dementia care, remain calm and compassionate. Trying different strategies and routines are the most important things to do. There are certainly times when it is counterproductive to attempt to convince a loved one that they are suffering from dementia. Unfortunately, it sometimes takes a crisis to get your loved one the help and support they need. As care providers, we continue to educate and care for ourselves with new approaches and ways to support our loved ones challenged with this condition.
